title: Successful implementation of a nurse-led teaching programme to independently administer subcutaneous methotrexate in the community setting to children with Crohn's disease.
abstract: BACKGROUND
  Methotrexate is increasingly used as a third line immunosuppression agent in children with Crohn's disease (CD). Methotrexate is traditionally administered in the hospital setting.
  
  
  OBJECTIVE
  To set up a nurse-led education programme to teach children/their parents to administer subcutaneous methotrexate in the community.
  
  
  METHODS
  All patients were given methotrexate over a 16-month period. Patient demographics including previous treatments were collected. A competency based teaching package was implemented by the inflammatory bowel disease nurse. Distances and travel times together with costings were calculated.
  
  
  RESULTS
  Thirty two patients (19 male; 13 female) with a median treatment age of 11.96 years (IQR 10.67-13.92) were studied. Thirty of 32 (17 children, 13 parents) were independently administering methotrexate. The median return journey distance to hospital was 23 miles (IQR 14.4-42.4) taking a median time of 52 min (IQR 41.0-73.5) for each injection. The total patient travel saving was £10,537 (average £730 per patient) and nursing time saving was £12,808 with home administration (total saving £23,345).
  
  
  CONCLUSIONS
  This paediatric study demonstrates that methotrexate injections can be given successfully in the majority (94%) of patients with CD independently in the community, resulting in significant time and money savings for patients and health professionals alike.
authors.affiliation: Department of Paediatric Gastroenterology, Yorkhill Hospital Division of Developmental Medicine, University of Glasgow, Glasgow, UK.
authors.forename: V
authors.initials: V
authors.lastname: Garrick
authors.forename: P
authors.initials: P
authors.lastname: Atwal
authors.forename: A R
authors.initials: AR
authors.lastname: Barclay
authors.forename: P
authors.initials: P
authors.lastname: McGrogan
authors.forename: R K
authors.initials: RK
authors.lastname: Russell
mesh_terms: D000293:Adolescent; D002648:Child; D003424:Crohn Disease / Q000188:drug therapy* / Q000191:economics; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000191:economics; D007279:Injections, Subcutaneous / Q000191:economics* / Q000379:methods; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000191:economics; D009720:Nurse Clinicians; D010290:Parents / Q000193:education; D012111:Residence Characteristics; D012189:Retrospective Studies; D012606:Scotland; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D008727:Methotrexate